One of the fundamental tenets of science is that if we can measure something, we know something about it. However, as Professor Miller points out, the level of intracranial pressure (ICP) may be less important than its cause. Moreover, focal pressure differentials may matter more than the average ICP measured at a sampling site. Probably, benign intracranial hypertension is tolerated so well because it is uniform.
Since raised ICP is the leading cause of death in intracranial catastrophes, measuring it has prognostic, if not therapeutic, value. However, before it is undertaken at least three questions should be addressed.
1. What is the prognosis of the underlying brain lesion? The prognosis must justify the effort. For example, a patient with increased ICP due to subarachnoid hemorrhage usually has the expectancy of a normal life if he survives the acute event. On the other hand, the majority of patients with massive
Hachinski V. Intracranial Pressure Monitoring. Arch Neurol. 1985;42(12):1196. doi:10.1001/archneur.1985.04060110078020
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